Lower blepharoplasty is a surgical procedure performed to improve the appearance of sagging, loose skin of the undereye area by removing redundant skin without undermining.
Where required, lower blepharoplasty may be combined with fat redrape to reposition fatty bulges. Because the fat redrape technique involves deeper level surgery, recovery time is significantly extended.
As we age, eyelid skin frequently becomes a concern prompting people to consider treatment to relieve heaviness and alleviate a tired appearance. To understand why these changes develop, we need to have an understanding of the anatomy of the eyelid area and understand the ageing process.
The prime role of the eyelids is to protect the eye to ensure that the cornea remains hydrated and provides a physical barrier to injury. As we age the brow falls a little allowing more skin to sit in the upper eyelid. This increases the overhanging skin fold and may give a sensation of heaviness. The quality of the skin changes also leading to crepey texture within the eyelid. The increased fold may therefore look cluttered and lose its sharpness. Fat may be apparent in the corners of the upper eyelid.
The lower eyelids are a more complex structure. They work against gravity and unfortunately the integral strength of the eyelid reduces as we age, leading to a lack of natural support. As the lower eyelid ages, it often leads to skin which is saggy and loose. This can lead to permanent lines around the eyes that are often known as “crows feet”.
Fat that is naturally present around the eye is kept in place by a structure called the orbital septum. As we age, the orbital septum becomes lax, allowing the fat to prolapse forwards. This gives the characteristic puffiness that commonly occurs with advancing age. With the above changes, the junction between the eyelid and the cheek falls, leading to hollow lines appearing. This gives the illusion of the eye becoming smaller.
In assessing the eyelids, we therefore need to assess the following-
The elements that need to be considered with lower lid blepharoplasty are
The approach to the lower lid is either through a small incision under the lash line or, if there is no
skin excess through the inner aspect of the eyelid (transconjunctival).
If skin is in excess then it may be removed, often by taking a small strip away just beneath the
eyelash line. The amount that can be removed is to some extent dependant on the tone of the
lower eyelid as in loose lids excessive removal can lead to lid malposition. Reducing skin is a
careful balancing act between skin tightness and lid position.
If muscle is excessive a small amount can be trimmed away but as muscle contributes to lid
structure this needs to be done carefully. Excess lateral muscle action leading to smile lines may
be effectively treated with botulinum toxin.
If fat bulges are present, the fat may be reduced, repositioned and re contoured. Occasionally fat
may need adding to hollows, this is accomplished with fat grafting either at the time of
blepharoplasty or as a separate procedure.
A detailed consultation with a consultant plastic surgeon is essential prior to undergoing any procedure of this nature. During the consultation, your surgeon will discuss any problem areas, desired improvements, options available (including no treatment at all) and expected outcomes.
Should a lower blepharoplasty be agreed upon as the most suitable treatment, the procedure will be carried out by your surgeon in our newly refurbished operating theatre.
Depending on preference, the surgery may be performed under either a local or a general anaesthetic. The skin is gently cleansed and the eyelid carefully marked, noting areas of fat bulging and skin excess. The incision is usually placed just below the eyelash line to help hide the resultant fine scar in a natural line. The skin is carefully lifted and any fat recontoured to improve the smoothness of the lower lid. After removing a small strip of excess skin and muscle, the wounds are carefully closed using very fine stitches.
Unfortunately not. The lines are due to muscle action and while we can reduce the muscle we cannot remove it all together. If we did, then the lid would be very floppy and droop. A better alternative is to use Botulinum Toxin to selectively relax the muscle fibres and soften the laughter lines safely.
It depends on the cause of the darkness. If the darkness is caused by shadows cast by bulging fat then recontouring the fat will help. However, if it is due to the skin being very thin and dark in colour then this will more than likely persist after surgery.
Malar bags or festoons are notoriously diffcult to treat and will not improve with standard lower blepharoplasty. They may be improved with a mid facial lift.
After surgery it is essential that you rest and avoid any vigorous exercise or activities that may
increase blood pressure and delay healing. Mild swelling and some bruising are to be expected
after this surgery, this reaches a maximum after 24-48 hours fading down usually by the 10th
postoperative day. Some minor bruising and swelling may persist after three weeks but this may
be easily disguised with the careful application of a concealer.
The fine stitches are removed after one week and specific instructions given on massage and
Application of local or general anaesthetic at the treatment site ensures total comfort for the duration of the procedure
The incision is usually placed just below the eyelash line to help hide the resultant fine scar in a natural line. The skin is carefully lifted and any fat recontoured to improve the smoothness of the lower lid
Results can be seen once sutures have been removed and post operative swelling has subsided
Mild swelling and some bruising are to be expected after this surgery, this reaches a maximum after 24-48 hours fading down usually by the 10th postoperative day
Whilst excess skin is permanently removed, eyelid surgery doesn’t stop the clock, it merely resets it. As time passes, the ageing process will once again progress.